Wednesday, December 14, 2011

Soothing holiday sadness as you remember absent loved ones

This is the time of the year when holiday shopping, decorations and celebrations exude an aura of happy anticipation: of family togetherness, of shared traditions, and of connecting through cards and other messages with far-flung friends and family. Why, then, does this time of the year bring feelings of yearning and sadness for some of us?

As we contemplate times of the year that revolve around family and memories of loved ones, it is natural for our thoughts also to turn to those loved ones who are unable to be with us. Whether because of illness, military duty, financial stress, conflicting obligations or other reasons, the absence of a loved one on a family oriented holiday can have a poignancy that is difficult to ignore. So what do we do with those thoughts of longing that cannot be satisfied?

Perhaps it would be helpful to distinguish between the different kinds of loss that we experience. I’ll focus especially on ambiguous loss, anticipatory loss and anniversary reactions, as a way of communicating that each loss is unique and may need different kinds of comfort and self-soothing in the midst of the surrounding holiday happiness.

Ambiguous Loss, first conceptualized by Pauline Boss of the University of Minnesota, is loss that is not complete. She identifies that in mourning some losses, we may have the person physically present but emotionally absent (examples of that would be a loved one with Alzheimer’s disease; chronic mental illness; addictions; brain injury or unconsciousness). The person’s physical presence, while a poignant reminder of the loved one’s previously more healthy self, is also a jarring disconnect from the person they have become. Likewise, another form of ambiguous loss occurs when the person is physically absent, but emotionally present (such as a person missing in action or in a natural disaster; kidnapped; incarcerated; or a runaway). In this kind of ambiguous loss the person, although not physically present, occupies a significant part of emotional devotion from those people who mourn that person’s physical absence, and the waiting that is necessary before learning of a safe return.

Since I write this blog with special attention to people experiencing infertility and pregnancy loss, let me say that ambiguous loss is especially familiar in these circumstances: when you have built in your own mind an image of the baby you hope to have, which I think of as a “fantasy baby.” This baby, although not physically present, is very real to you, but as each month passes without a pregnancy, your grief at feeling this fantasy baby slip away grows stronger. Conversely, a newborn baby can be present without the expected joyful emotional bonding. This might occur when a baby is born prematurely, since it is not the healthy, dimpled baby you had dreamed of cuddling and nursing but, instead, this infant is tiny and vulnerable, with its early life restricted to tubes and incubators. Under any of these circumstance, it is difficult to put a finger on what deserves to be mourned, especially as there is fear of loss, but no real closure or future yet to the relationship that you have been yearning for.

So ambiguous loss, especially during the holidays, represents both uncertainty and a changed perception from what we had anticipated as we looked to the future. In a sense we are relinquishing our hopes and dreams, sometimes putting our lives on hold, and trying to nourish relationships with friends and family who have some appreciation for the emotional dilemma that has become a part of our lives. Holiday time can be especially challenging, as we are aware of the “missing persons”, either physically or emotionally, who are not with us as are so many other family members celebrating the holidays.

Anticipatory Loss refers to the mourning we begin to do when learning of a serious diagnosis for ourselves or for a loved one. Terminal illnesses can evoke anticipatory mourning, both for the patient and for loved ones. Other serous diagnoses, such as macular degeneration, loss of limbs, or mastectomies, can alter physical mobility and physical appearance while also increasing dependence on others. As we continue to anticipate the loss and its effect on our relationship with loved ones, we often are assailed with feelings of helplessness and hopelessness. It is not unusual to begin to withdraw emotionally from the loved one who is given a serious diagnosis, because it is so painful to contemplate the future. In truth, this mourning has some therapeutic strengths, in that we are not denying reality, so much as trying to make sense of it emotionally. We may reach out to others to vent our sadness and frustration, we may join support groups where others can share their own struggles and support us in ours. But as the loss becomes more inevitable, those of us who have had the courage to express our love in the midst of impending loss will feel the emotional load evolving, rather than imprisoning us.

Couples grappling with infertility face the issue of anticipatory mourning as they are told that a pregnancy is not healthy or viable, as they receive a diagnosis that means they will not be able to conceive a healthy child, and as they are told by infertility specialists that they have idiopathic (or “unexplained”) infertility. They may gradually find themselves mourning the loss of the roles of birth parents and, instead, assessing whether they want to pursue other means of bringing children into their lives.

Holiday time, with so much emphasis on children, play, frivolity and fantasy, can grate on the hearts of people with infertility. In addition to the pain of not having a child to indulge at this time of the year, many people with infertility feel an undeserved sense of isolation, coupled with the fearful anticipation that birth parenthood may not be an option. Holiday time, with the coming together of distant friends and relatives who may not have seen one another for some time, also creates the awkwardness of questions about when you plan to have children or well-meaning warnings to be careful not to “wait too long.”

Anniversary Reactions: This is a reminder that on the anniversary of a loss, we possibly will have some kind of emotional reaction. Whenever I find myself feeling unexpectedly gloomy or inexplicably introspective, I have learned to ask myself whether I am approaching or in the midst of the anniversary of an emotional loss. Ninety percent of the time that what is happening. Sometimes the anniversary will be of a loved one’s death, birthday, wedding anniversary, or other special occasion when I would have picked up the telephone or sent a cheerful card. Other times, the anniversary may be a celebratory holiday when the loved one would have gathered with family in the days he or she was alive and healthy. I have learned over time that what works best for me is to anticipate an anniversary that may be associated with the loss of a loved one. I try to be especially kind to myself at those times, sometimes sharing my thoughts with friends or family members, or other times just creating quiet times for myself to be contemplative and to dwell on happy memories. For people who may not have completed their grief at the loss of a loved one, it is more likely that an anniversary will evoke feelings of sadness. This is especially true if the loss is an ambiguous loss, with closure feeling impossible and memories feeling unresolved.

For couples with infertility, anniversary reactions can mark such times as the beginning of infertility treatment (and accompanying disbelief that so much time has passed without a conception); a pregnancy loss (which, for many, will represent a continuing emotional attachment); a failed adoption; or a decision to move on to a child free life. The importance of being aware of these emotionally-charged anniversaries is that one can honor the past hopes and dreams while, at the same time, feeling invested in the new directions life may be taking. Holiday time tends to be felt as a reminder of last year’s anniversary, when one or both members of the couple held out hopes that by “this time” next year they might be cuddling an infant in their arms. As they watch nieces and nephews grow older with each holiday, it reinforces for them the passage of time and the diminishing likelihood that any baby born to or adopted by them will have current nieces and nephews as age-mates.

So, just as we may now understand the mix of holiday joy with the flip side of remembering absent loved ones, what do we do with that awareness? Of course each of us will handle the emotion of sadness differently. First it is important simply to acknowledge to yourself that joy and grief can co-exist. It is also helpful to find some quiet time to indulge your memories of the loved ones who are not able to share the joys of the holidays with you. Perhaps this also can include a more public sharing, such as reminiscences with others of the absent loved one, the baking of that person’s favorite holiday goodies, or the displaying of a photograph or possession that evokes memories of happier times together. And then, in the midst of what can become a hectic holiday, it is helpful to slow down enough to absorb the memories in a calm way. Playing soothing music, soaking in a warm tub, getting a massage, getting extra sleep, taking a peaceful walk, or doing a kindness for another person all constitute opportunities to change the rhythm of the holidays to a more calm and reflective time.

So in the spirit of finding some emotional balance in the midst of busy holiday celebrations, I wish you peacefulness as you find a path, and perhaps some company, to soothe your emotions in this celebratory season.

Monday, October 31, 2011

He Just Doesn't Get How To Comfort Me!

How many times have you found yourself frustrated that your significant other is unable to offer comfort at the very time you need it the most? Is he unable to see that your eyes are bloodshot? Is he incapable of empathizing with your pain? Or is he just afraid of your inevitable tears?

Well perhaps all three, in various combinations, could account for what feels like a loved one’s insensitivity. But is it really insensitivity? In today’s blog I’ll offer some suggestions for how you might encourage your partner to offer support when you need it most. For the sake of pronoun simplicity, I’m going to assume that you are a female and your partner is a male; but, if you are in a relationship where the genders differ from my examples, just substitute the genders that work for you.

The first thing is to do a bit of detective work. Are there times that your partner is immensely supportive? Are there circumstances when he does “get it” and doesn’t hesitate to offer emotional support? If so, you’re in luck, because that suggests that certain situations are ones that he shies away from, rather than every circumstance where you’re emotionally needy. So the next step in your detective work is to find a quiet time to raise with him your feelings of confusion. But first you’ll want to say something like “You know, I’m always so grateful when you give me emotional support. Like when I was so bummed out last month when I didn’t get the raise I expected, or earlier when I was frustrated that my boss was imposing unrealistic deadlines. It feels so good when you find just the words to comfort me. Have I ever told you that?” Hopefully he’ll respond with appreciation, which allows you to continue with something like “That’s why I’m so confused at those times that you seem oblivious to my sadness, like earlier this week when you had to have known I had been crying when I got my period or when the infertility clinic called to tell me they’d have to change our appointment, and I was frustrated to the point of tears. Both of those times you were just matter-of-fact when I really needed you to be more comforting.”

This level of inquiry moves you closer in several ways to understanding what could be going on. You want to be non-confrontational about this and ask for your partner’s help in understanding his perspective. You want to let him know that you do notice and appreciate those times that he offers emotional support. And you want to ask why there are times that he doesn’t offer the support that you need.

So here are some possible answers he might offer:

1. “You know, it’s a lot easier to offer support when you’re angry about something. You’re usually willing to talk about it, and even if you rant and rave, I feel like I’m doing something to help by letting you get it out of your system.”

2. “Well, in the examples you mentioned from your office, I felt frustrated on your behalf and, as I recall, after you settled down I offered several suggestions of strategies you might try with your boss.”

3. “Now that I think about it, I realize that any time you have a problem that brings you to tears, I feel pretty inadequate. It’s easier for me when you’re angry than when you’re sad.”

4. “Our infertility is such a source of sadness for both of us. I know I shy away from encouraging you to talk about it because it will bring up such sadness in me.”

5. “I know I can comfort you with talk about how to use different strategies. But when a problem like our infertility has defied both us and our doctors, I don’t know how to comfort you.”

So where does this detective work leave you? Actually, in quite a good place. You’ve learned in response #1 that your partner is comfortable with your anger and that he knows that being a good listener is something he can do. In response #2 he shows that he can empathize with your frustration and that he can mobilize his comforting techniques to include strategizing with you about possible next steps. In responses #3, 4 and 5 his reaction shows that he doesn’t know how to comfort you when you’re sad, especially over an issue that doesn’t have a clear solution and, even worse, if it arouses his own feelings of sadness. So we now know that there is a toxic issue that blocks his capacity to comfort you, and whether that issue is infertility, a chronic illness, a health problem, an emotional loss, or something else, the challenge you both face is how to share more fully the impact of this in your lives.

The good news is that (hopefully) there are either issues or emotions that your partner feels adequate to respond to in a comforting way. The challenging piece is to identify what issue(s) are red flags that make your partner feel inadequate or emotionally vulnerable. Once both of you can talk about his feeling more adequate and more emotionally supported, you are on your way to finding mutual comfort in your relationship.

So, for example, when your partner says he doesn’t know how to comfort you when you’re sad, what he really is saying is that none of his old behaviors (good listening, strategizing) seem up to the challenge. I often have been amazed to watch my female clients tell their partners what would comfort them when they’re sad (hugs, cuddling, some chocolate, undivided attention), only to have the partners say something like “You’re kidding! That’s all?” Some guys feel that if they can’t “fix” the problem there’s nothing more to be done. They don’t fully appreciate until you tell them clearly that there are ways to comfort you in your sadness, and that their very efforts to do so will be immensely reassuring. It also is possible that, in their own childhood homes, tears were toxic and comfort was never modeled. Helping your partner to understand what he can do to comfort you will be a gift to him. And, of course, once he begins to show his capacity for responding with empathy to your tears or emotional despair, your feedback and appreciation will help him to feel more adequate.

So next we need to think about the issue of emotional vulnerability that your sadness may evoke in your partner. The suggestion here is that the toxic issue is a shared issue, raising mutual sadness and perhaps some anticipatory mourning in each of you. And what we know about mourning is that it proceeds on different pathways for different people. So you and your partner may be in different places in your efforts to grieve, to make sense of a loss, or to make decisions about your future. There are several things for both of you to consider if emotional vulnerability is getting in the way of offering comfort. One is that, in spite of all the gender stereotypes that guys have grown up with, it is not the male’s responsibility always to be strong for his female partner. Here is where you need to say to him “This is a shared sadness and it would help me a lot if you could talk with me about the emotions it is bringing up in you.” Or “I feel lonely being the only one to share my feelings. I’m sure you have feelings too, and I really wish you would talk with me about them.” This effort to give one another mutual support can go a long way toward making both of you feel less vulnerable.

Another aspect of emotional vulnerability is the way in which it seems to stretch to fill every moment and every room. The worry is that once you bring up the toxic issue, it will overwhelm you. So there are two ways of trying to contain the emotionality associated with this issue (and the inevitable related ones) in your lives. One way is to agree to set limits on when and where you discuss the issue. I usually tell my clients to agree on a time limit they will respect: perhaps 15 minutes three times a week (with exceptions for crises and emergencies), and to identify a place in the house where these conversations can occur: absolutely not in the bedroom and preferably not in a place with frequent distractions or interruptions). Once you and your partner know that there will be times set aside each week for discussions, decisions and emotions, it becomes easier not to feel overwhelmed. A second way to address issues of emotional vulnerability is to talk with a therapist about constructive ways of coping (see my blog of 1/27/11 on “how to find a good psychotherapist”). This can be a good investment of both time and money, as it will set the stage for additional ways of being emotionally responsive to one another as partners, as well as helping both of you to understand any issues of grieving that you may be grappling with in different ways.

So when hoping to sensitize your partner to how to give you emotional comfort, your quest may actually have the effect of making your relationship mutually stronger. Not only will you have learned how to initiate good emotional detective work, but you also will have engaged your partner in sharing with you his feelings around whatever toxic issues you may encounter together in your lives.

Monday, October 3, 2011

Do you have kids? How toxic a question is that?

For many of us with a history of infertility, the prospect of meeting someone new carries with it a blip of apprehension, as we wonder whether we will need to respond to the inevitable question about whether we are parents. Of course new acquaintances intend it as a “getting to know you” question. We can feel it like a stab in the heart. And our answers can range from the factual to the emotional:

“No.” That answer is certainly an option, perhaps followed by a quick change of topic, to move conversation away altogether from this sadness. You won’t elicit any concern or sympathy, but perhaps you’re not ready for that from a new acquaintance – or maybe you’re so saturated that you want to be known for other things in your life besides your non-parent status.

“No, but we’re ever-hopeful.” So this answer leaves the door open to a quizzical glance, perhaps an inquiry about how long you have been trying, and some awareness that parenthood is not something you take for granted. Other new acquaintances will decide not to be intrusive with someone they have just met, and will change the subject, perhaps a bit awkwardly.

“No. We’ve been grappling with infertility, and we would love nothing more than to have a baby in our lives.”
Okay – now it’s out in the open, feelings and all. It doesn’t mean your new acquaintance will have an empathic response on the tip of his/her tongue, but at least you’ve given a clear signal that these topics (oh, yes, several of them!) are open for discussion.

“No. We’ve experienced a/several pregnancy losses, but we’re still hoping to become parents some day.” This honest answer, like the previous one, suggests a readiness to talk further if your new acquaintance follows through with some empathy.

“Not yet. But we’re/I’m in the process of pursuing IVF because 1) we’ve had difficulty conceiving 2) at my age, the doctor has suggested we will have our best luck with donor eggs 3) my lesbian partner and I want to have an embryo from her egg and donor sperm transferred to my uterus 4 ) I’m single and eager to become pregnant 5)my husband’s sperm need some extra help connecting with my egg.” WHOA! This puts any new acquaintances on notice that a conversation with you will be honest, as detailed as they ask for, and may stay on the topic of your reproductive status for a long time.

“Not yet. But we’re in the midst of investigating whether we can adopt a child. So we’re hoping for parenthood; we just don’t know when it might happen.” This is likely to be a conversation starter, since so many people know adoptive parents. If you offer information about your infertility, the conversation can go in that direction, but chances are that your decision to adopt will provide ample information about how your new acquaintance views this dimension of parenthood that you are trying so hopefully to pursue.

“Not yet, but my partner and I are working with a surrogate and hoping that she is successful in conceiving and giving birth to our first baby.” This is a unique enough way of bringing a child into your family that your new acquaintance either will be tongue tied (with ignorance or awkwardness) or full of questions. In any case, you’ll get a sense of whether this is someone you’re interested in getting to know better!

“Yes.” And here you are likely to offer a brief list of children’s genders and ages. This offers itself as a way of saying “I’m in ‘The Club’ ” without providing any information of your pathway to parenthood. This works well for many previously infertile parents, who want to close the chapter of their life devoted to infertility and fully engage in the new chapters of parenthood. That having been said, most of us know we look at parenthood differently with a history of infertility in our background.

“Yes. We have two little boys, and we had a pregnancy loss/ stillbirth/ infant death of our daughter two years ago.” Here you are honoring the loss of a hoped-for child who still may occupy a psychological presence in your home. It seems impossible to leave her out, yet you know that mentioning her loss may trigger some awkwardness. Since this loss has left you forever changed, you feel it is important to share this dimension of yourself.

“Yes. When they say ‘Be careful what you wish for’, we never dreamed our infertility treatment would result in triplets!” Certainly this will be a conversation starter, but probably more with an emphasis on the challenges of parenting than on the challenges of infertility!

There are probably other responses to the question about you and parenthood that have occurred in your experience. The question itself arises so informally in meeting someone, and yet it leaves you wondering how much to share about your circumstances. And since we all evolve over time in our readiness to talk openly about our infertility, you may find that several of the responses in this blog have been ones you have chosen at various times when meeting a new acquaintance.

That in itself reminds us that infertility is an unanticipated detour on our journey through adulthood. Much as we might have wished not to travel this infertility pathway, most of us try to do it with strength, with integrity, with partnership and with courage. We want friends who understand us and the challenges we face. At the same time we want friends who do not define us via our infertility, but who are reciprocal in our relationships, allowing us to help them when they too fall on difficult times. And it is that wish for reciprocity that poses the challenge as we “size up” a new acquaintance and decide how much to share, how much we can trust a compassionate response, and how much we want to confide how soon. The answers are different for each of us. The important thing is that we understand why a single, inviting question can sometimes feel so toxic…..

Thursday, September 8, 2011

Pregnancy at 40 -- How realistic is it?

Why is it that some women wait until they are 40 to begin trying to conceive? Is it that finally their lives have settled down enough to contemplate children as the next step? Are they in a new marriage that they hope will be blessed with parenthood? Is the tick of the biological clock getting louder and louder? Are they feeling out of sync as some of their friends are anticipating grandparenthood? Or, as a recent New York Times article posed, do women who physically look much younger than their age actually believe their 40-year-old eggs are up to the challenge of conceiving a healthy baby?

Certainly there are many reasons and circumstances that cause a woman to try to become pregnant. But waiting until age 40 is risky, no matter what one’s motivation. Particularly worrisome is the belief that it’s just fine to wait until the time “seems right.” I would be the last person to advocate trying for a pregnancy when the timing is all wrong – that’s risky in a different sort of way, as the consequences of adding a new baby to an already stressful life can be devastating for all concerned. But if there is a guiding assumption that becoming pregnant at (or after) 40 is a breeze for a healthy woman, then we need to challenge that assumption.

Let’s start with the information most of us were given in eighth grade health class: females are born with all their eggs, as opposed to males who begin producing sperm at puberty and continue to do so into old age; neither old eggs nor sperm of older men are as healthy as those of younger adults. Defective sperm or eggs can be at the source of infertility, pregnancy loss, or congenital defects in newborns. The most healthy fertile years for women are in their twenties, when their bodies are mature, when their eating habits (hopefully) are healthy, when they can understand what they are reading about good reproductive health, and when they are capable of restricting behaviors known to harm developing fetuses, such as smoking, drinking, or substance use.

So how is it that some women reach their forties assuming that conceiving and carrying a pregnancy to a healthy birth will be a smooth process? Some of these women have forgotten their eighth grade health class lessons and haven’t brushed up in the intervening years; others have never initiated a discussion with their ob-gyns about fertility and the risks of first trying to conceive in their late thirties; and still others, who have done everything to keep their bodies supple and young-looking, believe mistakenly that their bodies contain young and healthy eggs. In fact, their eggs are aging, with higher risks for chromosomal abnormalities, and their hormone levels are progressing closer to those of menopause with each passing year. By the time a woman is 40, most doctors would agree that her chances of getting pregnant each month are approximately 5 percent.

But women are increasingly being influenced by the sensationalist magazines in the grocery store, the Hollywood stars celebrating birthday number 40 with a baby (or multiples) in arms, and the television coverage given to sex-symbol actresses who, at age 40, are embracing new parenthood. No longer are woman and their partners being guided by the factual information about aging eggs and infertility. Or aging eggs and pregnancy loss. Or aging eggs and birth defects. Now only a prolonged inability to conceive or unexpected news from prenatal tests may be what shocks them into conversations with their ob-gyns or propels them to an infertility clinic.

That is when they are likely to learn the news that the Hollywood coverage never revealed: that donor eggs, donor sperm or a surrogate may be necessary for a woman in her 40’s to have a baby. This then becomes a new pathway that some couples decide to pursue. And for couples with determination, energy, patience and a significant amount of money, they may yet be able to bring a baby into their lives. But others may be deterred at the immense disruption that medical, legal and financial efforts will introduce into their relationship, their health and their work lives. For those women and their partners who once believed it was possible to use Hollywood as their guide in matters of fertility, the wake-up call may have come too late. And with more and more domestic and international adoption agencies placing age limit restrictions on prospective parents, the feelings of loss become even more profound.

How can we move beyond this gulf of misinformation and move women and couples more realistically in the direction of planning for parenthood? Clearly it would help if the Hollywood new 40-something parents would come clean and be open about the extraordinary means (including financial) they have pursued to welcome children into their lives. It also would be an important medical contribution if ob-gyns and Planned Parenthood staff would routinely query their patients about whether and when they are thinking about conceiving. And if those same reproductive health care offices had literature about infertility and pregnancy loss on their tables that are too often crowded with parenting magazines, it might lend a bit of balance to the way women view the issues on which their doctors can advise them.

Women have worked far too long for reproductive freedom to be thwarted by an unexpected twist of fate in our late 30’s and early 40’s. We need to talk with our peers, to encourage balanced reading material in ob-gyn waiting rooms, to raise with our sons and daughters the issues we hope they remember from their health classes, to advocate for insurance companies to cover costs associated with infertility, and to remember that reproductive advances come with many costs at many levels that just may be too much for the prospective 40-something parent to afford.

Thursday, August 18, 2011

Pre-Parenthood Perspectives of IVF Couples

Social science researchers (Fishel, A.K. et al) at Massachusetts General Hospital have completed an interesting study with couples who have given birth to a healthy baby following IVF treatment. Comparing these couples to what is known about couples who conceive without medical interventions, this study provides a unique lens into the pre-parenthood perspectives of couples who desperately want a healthy birth child.

Married couples who conceive without medical intervention have been studied for years. Generally, what is known about their transition to first-time parenthood is that (especially for couples who had not planned their pregnancy) there is a spike in divorce, a decline in marital satisfaction and the frequency of sex, increased depression in both men and women, a shift to a more traditional division of labor, and less time available for the couple after the baby is born. Generally these transition issues are less problematic for couples who had planned their first pregnancy and who had anticipated both their needs and their babies’ prior to the birth.

With the 16 couples interviewed in their last trimester for this study, the focus was on the impact of IVF on the couples’ expectations of parenting, on their work life, and on their marital relationship. Of course, we also must remember that, in addition to the disruption of IVF treatment, the shadow of months of infertility (and perhaps pregnancy loss) also may have taken a toll on self esteem, interpersonal relationships and the couple’s sexual relationship. These infertility issues, which I portray from the perspectives of several hundred women with infertility in my recent book When You’re Not Expecting, form a backdrop over which the additional tensions (and hopes) of IVF build and play out.

So what did the research find with this particular sample of IVF couples? First, we must keep in mind that they are a group not typical of all IVF couples. The 16 highly educated dual career couples interviewed were relatively young (average age of women was 34 and of men was 36). Most couples had conceived this pregnancy after only one IVF cycle and had experienced infertility for a relatively short period of time. Half of the men in the sample had an infertility problem, as compared with 30 percent in large studies. Yet, even as this small group may not be typical of IVF parents-to-be, the six themes that emerged from the interviews provide a unique window into how these couples are beginning to think about themselves as parents:
• A truncated view of the future. Few of the individuals said anything about what they imagined their lives to be like once the baby had arrived, nor did they have elaborated fantasies about the baby. It seemed as though they could not risk imagining they would really have a baby. Instead, they placed their focus on living from one medical appointment to another, very much as they had done during their IVF experience.
• Health fears. Almost all the couples talked about their fears about the baby’s health, and one quarter of them were concerned about the mother’s health. When a pregnancy has been medicalized via IVF, it is understandable that medical problems are a high priority for these couples.
• Gender of infertility factor. With the higher than usual percentage of these couples where the male factor contributed to the couple’s infertility, the men expressed guilt that their wives had to bear the brunt of IVF treatment.
• Multiple disruptions to work, particularly for women. Women, in particular, noted that IVF had required them to take time off for appointments, meaning that they needed job flexibility and a compassionate boss. Finding or remaining in a job where the health insurance covered infertility treatment was a factor for some women. More than half the women anticipated working less after the baby’s birth and already were aware of a loss of interest in their work.
• Unequivocal attitude toward parenting. The emphatic wish to become parents was accompanied by a lack of complaining about the pregnancy, the anticipated delivery and parenthood.
• Infertility as relationship strengthening. Almost half of the couples stated that the process of going through IVF had strengthened their relationship, though a small number said that their sexual relationship had been negatively impacted.

So what can we learn from this study, even as we recognize its small sample size that is not representative of IVF couples in general? The medicalization of their IVF experience seems to have focused couples on the present (rather than encouraging hopefulness and planning for new parenthood), and also has placed health issues in the forefront of the couples’ minds. The couples’ lack of ambivalence about the much-relished hope of parenthood has caused all of them to have a positive focus, which might benefit from some anticipation that less positive feelings like frustration, anxiety and exhaustion will probably accompany early parenting and should not be a cause for guilt. Yet, the emphasis on infertility as having been a source of growing strength in their relationship provides many IVF couples with a good foundation on which to build their new parenthood experience, hopefully reaching out to family and friends for the support all new parents need.

I have found in my counseling experience with infertile couples (whether their parenthood is achieved by good fortune, by reproductive technologies, by surrogacy or by adoption) that continuing counseling, although less frequently, is a good idea during the first year of new parenthood, as the joys and the challenges often have infertility as a poignant backdrop. Couples who understand the impact of infertility and medical treatment on their parenting experience often find that counseling enables them to sort out those complexities in creative ways. Issues such as rebounding from months of medicalized sex, deciding about birth control, discussing the timing of a subsequent pregnancy, or dealing with the urge to be over-protective can benefit from using a counselor as a sounding board.

Monday, July 11, 2011

In vitro fertilization: What's realistic to expect?

I’m a big fan of realism when it comes to infertility, because operating on false hope can get in the way of making realistic plans for parenthood. So many people view in vitro fertilization as an expensive and effective magic wand to wave to make pregnancy possible. In today’s blog I’ll try to present the facts, as well as the emotional considerations, about how soon (and for how long) to rely on IVF for fulfilling hopes of a healthy pregnancy.

Last week, at a meeting of the European Society for Human Reproduction and Embryology in Stockholm, scientists discussed new research into how eggs and embryos develop and how to predict and prevent miscarriages in infertile women. However, scientists there agreed that even that knowledge is unlikely to radically boost the chances of most infertile couples trying to achieve a healthy pregnancy.

So let’s first look briefly at why IVF carries such a hopeful aura. Hollywood is a good place to start, with many starlets crediting IVF for their pregnancies – and, if we look closely at the ages of many of these women becoming pregnant (sometimes with multiples), we also know that IVF may deserve the credit even if they don’t share that information with the public. So Hollywood IVF babies get lots of publicity, leading the reader to believe that it’s a procedure that can bring happy parenthood after months or years of infertility.

And, speaking of multiples, publicity attached to octomoms Nadya Suleyman and Kate Gosselin has grabbed and held the public’s attention for months on end. Exhausting as their lives are, anyone touched by infertility yearns for the physical exhaustion of new parenthood as a welcome replacement for the emotional exhaustion of infertility. So IVF has moved into the mainstream of family-making in ways one couldn’t have imagined just a few decades ago.

On July 25, 1978, Louise Brown became the first baby born as a result of IVF. Since that time the number has swelled to several million babies born worldwide from IVF and other assisted reproductive technologies. Yet, despite these large numbers, the success rate of IVF has climbed only modestly since 1978. About 15 years ago the IVF success rate was about 10 percent; today it is about 25 percent. Some clinics will calculate their statistics according to the age and health of the prospective mother, so data exist showing that the rate can be as high as 50 percent. However, even those impressive rates don’t usually reveal the hidden issues, such as costs, number of IVF procedures before a healthy pregnancy and life/employment disruption in general.

So, if you or a loved one is considering IVF, here are some things to think about before the Hollywood bandwagon sweeps you aboard.

• Many people move too quickly into IVF, when less costly procedures can be highly effective. I always encourage people with infertility issues to become affiliated with an infertility clinic (which will view the couple as the patient and will offer services 24/7 instead of being closed on holiday s and weekends when carefully-timed procedures may need to be scheduled). But this does not mean the infertility clinic will immediately offer high tech interventions when more basic procedures may be successful. Ideally a clinic’s goal is to be efficient and effective, with a variety of specialists available to offer treatment options.
• As you are selecting an infertility clinic, you are likely to be drawn to those that are geographically nearby. You will want to ask about their IVF success rates. Keep in mind that many clinics “adjust” their success rates to reflect high numbers. The number that matters to you is the number of healthy births (not chemical pregnancies or unsuccessful pregnancies) for women of your age. Some clinics restrict admissions to healthy couples within a certain age range which will optimize their likelihood of success with all reproductive technologies. This is why some clinics will be able to claim a 50 percent success rate with IVF.
• Whatever treatment you are receiving, be sure that you and your infertility specialist have a game plan for how long to continue that particular intervention before advancing to the next one. This will maximize the likelihood of being efficient and not staying with a particular treatment past the number of times it is likely to be effective.
• Not everyone has the money or the stamina for what is involved with IVF: the woman must take drugs to suppress and then to stimulate her reproductive system, and this involves taking pills and giving yourself shots each day. Daily blood tests and ultrasounds are necessary before eggs are retrieved, sperm are added and the embryos develop in a petri dish, and after three to five days the embryos are either implanted into the womb or are frozen for later use. In the last few years, doctors in the U.S. aim to implant only one or two embryos in most women, cutting the risk of multiple births to about 2 percent, the same risk as in the general population.
• Although the medical treatment is physically disruptive, emotional disruption is an issue for most couples as well. Employment juggling, exhaustion, depression and dealing with feeling out of control are all common issues during infertility treatment. Be sure to check to see whether your infertility clinic offers counseling, and don’t hesitate to explore whether counseling can take the edge off of your emotional life.
• You need to be paying attention to your budget and savings account throughout the period of your infertility treatments. Remember that there is only a 25 percent chance of a healthy pregnancy in most cases using IVF, yet each IVF cycle will cost more than $12,000. Check with your insurance provider to find out whether any costs of infertility diagnosis or treatment (including IVF) are covered for you.
• One reason you need to be highly aware of your dwindling savings account is that individuals and couples considering adoption if a healthy birth never happens, will need to have money and emotional energy for domestic or international adoption. Early on in your infertility treatment you may not feel open to considering adoption, but as month after month of regular periods diminish your hopes for a birth child, your personal perspectives on parenthood may expand to include adoption. And you’ll want to have enough money to pursue that dream.

So that leaves U.S. couples aware that good health and a woman’s age are crucial factors that increase the likelihood of having a successful pregnancy. And, as efforts to become pregnant deplete your savings account and your emotional energy you may find the voices of women in my recent book helpful as you consider other options (When You’re NOT Expecting: Chapter 10: Ending Treatment: when enough is enough; Chapter 11: Different Dreams: opening new doors to life). I’m a great believer that joining hands and hearts with others who have experienced infertility can sustain you emotionally during your creative, yet realistic, efforts to pursue parenthood.

Thursday, June 30, 2011

When Hopes for a Happy Pregnancy are Disrupted

It happens. The early joy of a much-wanted pregnancy is suddenly shattered by something unexpected. Whether your partner (imagine former US Congressman Anthony Weiner) reveals some giant stupidity that makes you question whether you want this person in your life anymore; whether your physician delivers some troubling news (imagine a Down Syndrome diagnosis) from a prenatal test; or whether a family catastrophe (imagine being laid off from your job and losing your health insurance) takes over your life, stifling the joy that had nourished your spirit, you feel as if you are in the midst of an emotional balancing act with no acrobatic training.

So how do you cope when a joyful pregnancy is no longer in the center of your life because your partner has demonstrated an emotional betrayal, an act of extreme stupidity or some other unexpected dimension of behavior that you never would have thought possible? As you are re-grouping, you could be weighing whether to remain in the relationship, whether to continue the pregnancy or whether to consider placing the baby for adoption. Each one of these issues feels life changing and overwhelming. And, given the betrayal exhibited by your partner, you may feel reluctant to confide in close friends and family, since you don’t want to face yet more pressure from them about what actions you “should” take. You also need desperately to vent, but hopefully are careful about saying too much too soon. So here is where an excellent option is to seek counseling from a professional who practices marriage and family therapy. This could be a psychologist, a social worker, or a marriage and family therapist. Some pastoral counselors will have this training as well. As I have said in earlier blogs, as well as in chapter 7 of my book When You’re Not Expecting, there are several ways to locate a therapist: recommendations from friends or clergy, names provided by your county mental health clinic, suggestions from a hospital social worker, or contacting your local family service agency. Plan to present yourself as someone who is experiencing a crisis, which will minimize the likelihood of being placed on a wait list. And be persistent in asking for services – if you are concerned that you cannot afford them, ask whether the agency or the therapist has a sliding fee scale. But the bottom line here is that it is important to receive emotional support and guidance in this difficult time from someone who appreciates the complexity of your dilemma AND who has the professional perspective to guide you through the decisions you will face in the months ahead.

Troubling medical news from prenatal tests can be immensely disruptive emotionally. Although the opportunity to learn early about genetic or other developmental disorders is important to expectant parents, the flip side of this opportunity is that often tests cannot predict the extent to which a particular abnormality will affect the developing fetus. This places many parents in an immensely difficult position. Clearly the first goal is to learn as much as possible; medically this may involve more specific tests or a consultations with specialists; emotionally you may very well want to meet parents of children born with the disability (being sure to include children both severely affected as well as minimally affected); and you will want to learn about community support services for children with the special needs that your child may have. All of this information presents a particular challenge to prospective parents who may be considering terminating the pregnancy or placing the baby for adoption. And, of course, your view of your pregnancy is forever changed; you now are apprehensive, anxious and fearful at the same time you also may be feeling protective and hopeful. Prospective parents who make the decision to terminate the pregnancy often choose to present the loss as a miscarriage, in large part to protect themselves from the judgmental reactions of others. Some will be forthright with close friends and family about the careful thought they gave to this wrenching decision. And all will be very careful in subsequent pregnancies to receive early genetic counseling and prenatal testing, as a way of being informed about any risk factors.

In addition to partner woes or worries about the health of a developing fetus, other life catastrophes can take a huge toll on the happiness initially associated with a pregnancy. These days financial issues, unemployment, home foreclosure, family illnesses and other unanticipated crises can be a significant source of worry and uncertainty. Sometimes we have some control or influence over these situations, and other times there is little we can do. Given that anxiety is usually associated with loss of control, perhaps the one antidote is to remain as calm as possible in the figurative “eye” of the situational storm. Since it is known that the cortisol associated with stress can enter the fetus’s bloodstream via the placenta, remaining calm is for the health of the fetus as well as your own. In addition to considering counseling as one path to take in addressing sources of stress, relaxation efforts and mindful behavior also can help you to feel more centered as your pregnancy progresses. The kind of counseling that is most appropriate in dealing with situational stress is cognitive behavioral therapy, where a therapist will help you to re-frame your tensions differently and more manageably. After helping you to think about constructive ways to address the stress, the therapist will offer support and encouragement each step of the way. Not only are you learning about problem management, but you also are learning skills that will be excellent for future difficulties that initially seem overwhelming. Deep breathing exercises, yoga, and mindful relaxation are additional skills you can learn to help you calm your body and your mind when tension intrudes. It can be empowering to learn that even when you cannot change a particular situation, you can exert some control over how you respond to it and the extent to which you allow its stress to affect you.

An initially happy pregnancy can be threatened with worry or misery for a wide variety of reasons. Often our initial reaction at such a time is to turn to friends and family for help and support. After all, haven’t they been there for you in other times of stress? Perhaps. But the examples in this blog go beyond the skills and knowledge that our informal networks typically possess. So, in addition to dealing with the current disruption to the joy in your pregnancy, you also will need to stretch yourself to consider how to access necessary support and skills. Use the web, use the yellow pages, use your spiritual leader or health care professionals, and do it in the spirit of moving forward to learn the acrobatic training for this uninvited interruption in the joy you deserve to nourish.

Monday, June 13, 2011

Fathers' Day: A holiday of gratitude or yearning?

Fathers’ Day is a holiday that is so visible you can’t miss it! Advertisements, greeting cards, gift ideas, restaurant (or home grilling) choices… everywhere is filled with the importance of this holiday. But fatherhood is complex. Some of us can genuinely express gratitude to our father on this holiday. Others may have several fathers or father figures, with each representing a unique relationship. And then there are the men who yearn to be fathers but, because of personal or partner infertility, lack of a female partner or singlehood, cannot easily attain that coveted role.

So for those readers who have a positive relationship with a father, this holiday is just one day to express your love and caring to this special man in your life. It’s easy to focus these feelings on a holiday, but it’s important to know that spontaneous expressions of gratitude or sharing special memories can occur whenever the spirit moves you. Count yourself very fortunate to have this father in your life.

For many readers, Fathers’ Day is a time to weigh the differing relationships you have had with fathers and father figures. Complexity can be a challenge when a highly visible holiday suggests one father, positive feelings, and a life of shared experiences. If you have had various father figures in your life, this holiday is a time to decide how (or, perhaps, whether) to connect with them. Whatever you decide, aim to be genuine in your expression of what each relationship has meant to you over the years. This may include references to your differences, disappointments and difficulties, but even with the challenges, you may have emerged at a place where your gratitude is genuine. Relationships with fathers are an evolving experience, so hopefully you can capture some recollections to share even if the relationship may have become distant over time.

Likewise, fathers themselves may use this holiday to renew ties with birth children, adopted children, foster children, adult children and other folks of a younger generation with whom you have had a special relationship. If these relationships are ones that are valued, then think about shared meals, shared time together, or shared plans for getting together in the future that both of you can look forward to. There’s nothing magical about the holiday itself, but if it serves as a reminder that you would like to be more connected, then go for it!

But it is the men who yearn to be fathers for whom I have a special empathy on Fathers’ Day. They are the forgotten guys in the shadows of elusive parenthood. They are the ones who don’t yearn for cards or gifts but, rather, for a son or a daughter to cherish. And they feel invisible, except to their partners, on this day when their incapacity to father a child reminds them sharply of this missing role in their lives. So how to turn Fathers’ Day into something other than a day of yearning? That question will depend somewhat on your circumstances.

If infertility is the barrier between becoming a father or not, hopefully you and your partner are being diagnosed and treated at an infertility clinic, where each couple is assessed carefully by a team of health care professionals. That team should be sharing with you a timeline and a game plan for treatment, so that you don’t linger unnecessarily in the same treatment and can move to another level as medically appropriate. However, be careful with your finances, since infertility treatment can be enormously expensive and, for some couples, reduces their savings so that other choices, like adoption or surrogacy, are not an easy option economically.

Lack of a female partner is another barrier to fatherhood. For gay men wanting to become fathers, adoption and surrogacy are the major options to pursue. The “Resources” section of my recent book When You’re Not Expecting has listings of agencies that gay men will find supportive and informative in their quest for parenthood. The challenges posed by surrogacy are finding a reputable agency, handling the expenses, and deciding whose sperm will be used to conceive the baby. Some men request that their surrogate to use sperm from both of them to fertilize her eggs, while others will be more specific about which man’s sperm will be used during the insemination procedure(s). Men who choose surrogacy as an option usually identify genetic connections as important, prefer to adopt an infant, and may wish to use the same surrogate for future pregnancies, so the siblings would have a genetic connection. Adoption, which is likely to be a less expensive option than surrogacy, also should be pursued using a reputable agency. Many gay partners say that healthy infants are more likely to be matched with heterosexual couples, whereas older children, children with special needs and sibling groups are likely to be available for adoption by single parents and same sex partners. International adoption may widen the availability of adoptable infants and children, although some countries are very strict about such issues as marital status and heterosexual couples when releasing children for adoption. It is good to inquire about the average waiting time from application to adoption, learn whether travelling to the country is expected by the agency, and to understand fully any hidden costs or requirements associated with an international adoption.

Many of the same issues will pertain to single men wishing to adopt that I have indicated in discussing the challenges and rewards of gay couples adopting. However, there is one caveat I will offer. If you are a single gay male wishing to adopt, do not present yourself as heterosexual in the hopes it will enhance your chances of being matched with a child. Complete truthfulness is essential in the adoption process, in order not to risk voiding the adoption if later there is proof that deception occurred. This sounds harsh, I know, but any lawyer would tell you the same information. As with any single parent planning to adopt, you will want to assess your financial security, as well as your emotional support network who will join with you in loving your child and providing experiences and a sense of “chosen kin” that will be so important to both of you.

For further reading on the challenges of Fathers’ Day faced by men who are trying to become parents, I encourage readers to view the website of RESOLVE, the national infertility association ( This week there is a focus on Fathers’ Day that is both sensitive and encouraging for men who are yearning to become fathers.

Thursday, June 2, 2011

Can We Learn Anything From Tornadoes About Resilience?

As coverage of tornadoes across the US has filled pages of newspapers and hours of newscasters’ time, I find myself speculating about the larger lessons that may lie beneath the shattered landscape left in a tornado’s wake. Issues of coping with loss, recovering from devastation and seeking support are universal in many tragedies we face over the course of our lives.

None of us invites tragedy. Sometimes it comes upon our lives slowly; other times it strikes like a bolt out of the blue. Yet when tragedy touches us or our loved ones, it may be helpful to have thought about how people salvage their lives and move forward with resilience. In reading about the recent tornadoes in the US, a few of which have caused me to retreat to a cramped crawl space in my own basement as sirens screamed in the distance, I have felt relief at being spared from the damage that people in nearby communities have experienced. Sometimes I have felt survivor’s guilt. And other times I have felt like a ghoul as I find myself riveted by news reports in the aftermath of the wreckage. So I’ve tried in my own mind to think about how I might sort out my life if it were upended by a tornado – by which I could mean a violent act of weather, but I also could mean any event that rips me from my psychological moorings.

Coping with loss: I have lived enough years by now, and counseled enough grief-stricken clients, to have more than a passing familiarity with the emotional devastation that loss can bring. Although each person handles loss differently, I have found that North American culture often communicates the expectation that people should get on with their lives after a loss. And yet, for most people, it takes time to absorb the meaning of any loss. A year after a loss, when anniversaries have passed without the loved one, most survivors will say that it has been the comfort of family and friends that has enabled them to face each day. Some also will say that a ritual following the loss or a memorial to a loved one has helped to sustain them during their time of grief. But, most of all, grieving people will say that they have needed a shoulder to lean on, someone to talk to and a chance to review the circumstances leading to the loss to try to make some sense of the tragedy. And they will feel relief if their support systems are willing to be good listeners, neither judging nor hastening them to get on with their lives. Sometimes, as in the case of chronic health problems, terminal illnesses or infertility, the impact of loss grows heavier over time; conversely, when someone dies unexpectedly or there is a pregnancy loss, it is the suddenness of this event that leaves us emotionally adrift. So, whether for ourselves or loved ones, it is important to respect the unique pace each person needs in the process of healing, as well as the importance of support during the months and years that follow.

Recovering from devastation: At the memorial service of a friend a few years ago, one eulogy mentioned the decreased person’s frequent proclamation that “It’s just ‘stuff’”! As this friend had coped with his terminal illness, he was reminding others around him about what mattered, and it wasn’t the material possessions they were fussing over. We hear of tornado survivors who celebrate that they are alive and that their friends are alive, while proclaiming that life is what matters most as they contemplate rebuilding their lives. In watching coverage of families who have lost their homes, their scrapbooks, and their treasures of a lifetime, only to reclaim shreds of their possessions, I find myself wondering about what I value in my life and how I would tolerate the loss of a valued object. With this tornado mindset, I have donated many bags of clothing to charity, tried to simplify my life so I am able to spend time doing what brings me joy, and remained thankful daily that life in the moment is worth celebrating. I would hope that if/when devastation strikes, I could separate “stuff” from substance, lean on loved ones, and fortify whatever resilience I could muster in the wake of any personal storm.

Seeking support: In both of the earlier paragraphs I have emphasized the importance of leaning on others, even in a society that expects we should be able to bounce back quickly from catastrophes. And, since these catastrophes may very well have touched the lives of loved ones, I have found that it is wise to maintain relationships with a diverse network of caring people. Whether professionals (clergy, therapists, health care professionals), friends, mentors, neighbors, co-workers or distant folks who care about you, it is important to stay in touch or to extend emotional support when needed, in part because you may need to ask for such support in return some day. Not all folks will be available or emotionally able to connect with us on every issue, so it pays to think over the months and years about which people we feel most ready to confide in on which issues. As life changes, we change. But remembering to stay in touch with caring people of all ages is one way of being able to be responsive to their requests for help, as well as to call on them when your own life’s storms are just too much.

In writing today’s blog, I hope I am striking a responsive chord in some readers who, like me, are aware that, actually or figuratively, tornadoes can appear without warning on the horizon. If they strike, hopefully we can feel empowered to honor our emotions, to rebuild our lives and to seek support of various dimensions from the caring and concerned people in our lives.

Thursday, May 19, 2011

Rebounding from Springtime Stress!

Even as bright flowers, longer hours of sunshine and gradual warmth abound in the spring, many of us have encountered emotional potholes in this otherwise cheerful season. Whether you are rebounding from the stress of Spring holidays, winter weight gain or infertility, here are some thoughts on how to set your sights on moving forward!

HOLIDAYS are a time when we are expected to be celebratory. But the gathering of families, complete with familiar roles and lurking conflicts, can contribute to tension of spring holidays like Easter, Passover, Mother’s Day and Father’s Day. Not surprisingly, these spring holidays have a theme of life and reproduction running through them, which can be haunting for families who have lost a loved one or whose infertility prevents them from being celebrated as a mother or a father. If you are rebounding from feelings of disappointment or regrets associated with any of these holidays, you may want to spend some quiet time thinking through what you would like to have done differently this year. Perhaps you might have been involved with more supportive family members? Interspersed a family gathering with some quiet time or a stroll with a loved one? Called a friend who shares your sadness associated with a holiday so you could offer support to one another? It’s a challenge to feel entitled to emotions of regret when others around you are celebrating. But if you have these emotions, try to talk about them with a loved one. And, in addition to considering that you are rebounding from some stress now, also keep in mind for next year what strategies you might plan in advance as spring holidays approach.

HEALTHY WEIGHT is always a goal to strive for, but as spring approaches and our heavy sweaters no longer disguise the pounds we wish we could lose, stress can be one response to that realization. But if you’re trying to rebound from that stress, find a friend who can join with you in some healthy resolutions. Perhaps you can plan a brisk walk on a regular basis. Or join a gym and take some classes. Or sign up for a weight loss program. All of these possibilities give you the support of others, as well as the motivation to “stick with it.” Then there are some more solitary behaviors that may feel more possible to embrace now that spring fruits and vegetables offer opportunities for healthy eating. Brian Wansink, a professor at Cornell University who focuses on food psychology, reminds us that mindless eating causes people to consume far more calories daily than we are aware. He and other food experts encourage people not to include eating as a part of their multitasking but, rather, to focus clearly on being aware of food in all its dimensions: its taste, texture, color, flavor and deliciousness. As someone who researches the size and shape of our serving dishes, Wansink encourages us to use smaller plates and glasses for our food and drink as a way of controlling portions. And, in the spirit of mindful eating, many nutritionists stress the importance of focusing on food as it is being consumed at the meal table, rather than in front of the TV, while multitasking with our mobile devices, and to avoid sampling food while preparing a meal or nibbling a few last bites of leftovers before washing the dishes. For many people, specific medications may contribute to weight gain. This can be a side effect of some antidepressants. Hormone treatments used by women being treated for infertility may also cause weight gain and mood swings. So it is useful for everyone to try to pinpoint the underlying cause of unwelcome pounds before you make a plan to rebound toward a healthier weight in the spring months.

INFERTILITY can feel especially emotion-laden in the spring. Heavy clothing is coming off of both close and casual acquaintances, sometimes to reveal baby bumps. Mothers are pushing strollers everywhere outdoors, so it no longer is enough to avoid the local mall if infants bring envious tears to your eyes. And, then there have been the spring holidays, replete with pregnant and nursing relatives, flowers and eggs as celebratory reminders of fertility, and (we take a deep breath here) Mother’s Day and (yet to come) Father’s Day. So how can you feel you’re rebounding when reminders of your infertility are lurking at every turn? For starters, we can remember that Spring is also a season of “beginnings.” So now is a good time to think about taking new action in addressing your hopes for parenthood. If you’ve been relying on local physicians, now might be a good time to seek the services of an infertility clinic which, among its many advantages, diagnoses and treats both the male and the female as time-efficiently as possible. Another service provided by many infertility clinics is individual, couple and group counseling. You may feel that you’re coping okay, thank you, but keep in mind that counseling can offer new coping strategies that you might not have considered or tried. So even if you’re not a patient at a clinic that offers counseling, think about going to some support group meetings in your locale (consult the RESOLVE website at or seeking out a counselor in your community who can help you over the inevitable rough spots, as well as suggest strategies that will strengthen your emotional resilience. And, as readers of my recently-published book know (When You’re Not Expecting), emotional support during infertility can also be offered between the covers of a book – mine captures the words of a sisterhood of several hundred infertility survivors, each of whom shares her own strategies of coping across the entire spectrum of infertility diagnosis, treatment and pregnancy loss. And as I mention pregnancy loss, let me say that many couples who have had this emotion-laden experience and later grief over shattered dreams find that counseling can ease the pain, especially as a counselor will be the first to understand when you confide that loved ones seem to want you to “get back to your old selves,” rather than giving you support as you strive to rebuild your lives. One way many couples use the springtime is to plant a memory garden to honor a lost pregnancy or a stillborn infant. Although you will want to be aware that you may, at some point, move away from your current home with its memory garden, the very designing of it, as well as the process of planting, can feel therapeutic. Should you move, you may decide to preserve the garden in a photograph or painting you hang in your new home or to re-create the garden at your new residence. So spring flowers can be both an emotional tribute and a poignant reminder of dreams deferred. Lastly, in the spirit of rebounding, now is a good time, before Father’s Day arrives, to think about how you have coped with the challenges of your infertility this spring, and what you might try to do differently next spring with its reminders of fertility at every turn.

So, as we think of rebounding in the spring, whether it is from the stress of spring holidays, unwelcome weight, or infertility, the real issue is how to think about the stress as an ongoing learning experience. Stress is with us in all seasons, for lots of different reasons. What matters more than the existence of stress is how we use those experiences to move forward rather than to get emotionally bogged down with anger, regrets and self-blame. So, whatever issue in this blog resonates most strongly for you, take the rebound perspective (start with small steps) and see whether you can feel empowered to use the spring as a season of positive change. Good luck!

Friday, April 22, 2011

Am I A Mothers' Day Grinch?

Am I a Mothers’ Day Grinch? Not exactly, but today I’d like to present a perspective that is different from that depicted on Hallmark cards: the perspective of families who need some extra compassion on this holiday.

With Mothers’ Day falling this year on Sunday, May 8, now is a good time to think through how the meaning of this holiday for you may differ from the meaning it holds for some friends and family members.

Families without mothers. Even as I write this title, I feel some personal sadness. My own mother died over 30 years ago, after many years of my celebrating this holiday to honor her. Not only would I send flowers and, if distance prevented our spending the day together, we’d have a long phone conversation in which I’d tell her how much she meant to me, and I’d also remind my younger brothers to be sure to connect with Mom. In those days, Mothers’ Day was about MY mother. Following her death it became a holiday with mixed emotions, as I cherish her memory while, at the same time, wishing that her life could still be a part of my life.

In my early 30’s I was diagnosed with infertility. All of a sudden Mothers’ Day was “in my face” for at least a month before the actual day occurred. Every time I opened a newspaper or a magazine I would find stories of mothers. Every time I turned on the TV or radio, there would be some attention to the approaching Mothers’ Day and the opportunities families had for celebrating it. And in all the media would be reminders to make reservations at a favorite restaurant for a Mothers' Day meal. And there I was, wishing like anything I could be a mother. Not so that I could celebrate this holiday so much but, rather, to satisfy my craving for cuddling an infant in my arms. My husband and I did find ways of escaping the holiday hoop-la, but even with our efforts to plant a garden or play some golf or take a leisurely walk in a nearby state park, I still knew that others were celebrating a holiday I could not call my own. It wasn’t fun in those days.

As many of you know from my recent book When You’re Not Expecting, I have counseled hundreds of individuals and couples with infertility. Each year as Mothers’ Day approached I would ask my clients to anticipate this holiday, think through its meaning for them, and try to find creative ways of deciding how to spend it. Some celebrated the holiday with their mothers or their mothers-in-law. Others used the day to connect with nature in some way, to indulge in a short trip, or to have a potluck dinner with other infertile friends who, like them, dreaded this particular holiday. So, while I won’t go so far as to think of myself as a Mothers’ Day Grinch, I do own up to my role in helping my clients to figure out how this holiday could be less painful for them.

Another group for whom Mothers’ Day is poignantly painful includes those individuals and couples who have experienced a pregnancy loss or an infant death. Since, with regard to pregnancy losses, there are no rituals to memorialize the pregnancy loss (and often no mementoes to save, except perhaps a sonogram photo), the mourning parents may feel especially emotionally vulnerable on a day that honors mothers. If an infant has died, there may have been a service, sympathetic loved ones, and a gravestone in a cemetery, but in American society there often is the assumption that emotional recovery equates with putting the loss “to rest.” So loved ones may not be at all aware of the emptiness of a Mothers’ Day for parents who, even years later, are grieving the death of their infant.

In my life more recently, I’ve needed to extend comfort on Mothers’ Day to my two nieces, ages 12 and 14, whose mother died unexpectedly just 16 months ago. It was especially difficult to comfort them last year, their first Mothers’ Day without her, but this year as well they remind me that Mothers’ Day will never be the same for them. And they’re right. So I talk with them and their dad (my brother) about how they can embrace Mothers’ Day in a different way than their friends’ families are doing. This year they have decided to lay flowers on her tombstone, and then to go hiking outdoors, away from the visible celebrations in restaurants. If the weather is too inclement, they have a backup plan – a movie followed by takeout food they can enjoy at home. For them, as for other families without mothers, having a plan for the family to enjoy themselves gives them an emotional cushion when faced with families in their community who are celebrating the holiday that will never be what it once was in their family.

Families whose mothers are at a physical or an emotional distance. These families could include grandparents raising grandchildren, children in foster care, children whose fathers have custody of them, children who perceive their mothers as abusive and adolescents who have left home because of family conflict. Mothers’ Day is likely to touch these family members in different ways, often with considerable ambivalence and wishes for greater closeness with this parent who does not live with them.

Another family where mothers may be physically separated from their children could include immigrant families, either because the children have not yet come to the United States to join their parent(s) or because, in the case of some undocumented Chinese immigrants, their infants are sent back to China to be raised by the grandparents until the immigrant parents in the US have enough economic security to provide a home for their young child being raised in China. Another immigrant group where parents and children may be separated for periods of time includes agricultural workers who travel entire geographical regions sowing or harvesting seasonal crops. Living circumstances can be very chaotic for these families, with low wages added to the uncertainty of living quarters.

Childfree families: In couples who have decided not to have children because they are infertile and unable for various reasons to bring a child into their family, Mothers’ Day can be bittersweet. Many couples have ultimately made their peace with being childfree, whereas others still carry feelings of sadness and regret for the door to parenthood that has closed in their lives. Other couples have a firm commitment to remain childfree, a decision they reached after careful thought and, perhaps, after bucking their parents, in-laws and loved ones who urged them to consider the joys of having children in their lives. Indeed, many childfree couples do have children in their lives, but not as offspring; they are likely to look at Mothers’ Day as an observance they can share with friends and relatives who invite them to their holiday meal.

Where do we go from here? So now I’ve elaborated on those families where Mothers’ Day evokes feelings of sadness and regret rather than the glow of happiness most people anticipate from women of childbearing age. And, as you may have gathered, my hope is to encourage readers to think about how we can be sensitive to those women who are not mothers.

I think a great deal of grief could be avoided by not wishing every female in sight a “Happy Mothers’ Day!” It doesn’t pay to assume they are mothers and, if they are, chances are they have figured out how to enjoy this day.

Be on the lookout for well-meaning folks who are possessed with the Mothers’ Day spirit. I am thinking particularly of religious leaders who, with the best intentions in the world, decide to honor the mothers in their congregations on Mothers’ Day, either by giving them corsages, having them stand for recognition, or by having a special reception after the service. I cannot tell you how many of my clients and friends have been blindsided by a religious service in which they felt invisible, not honored and generally discounted. If your place of worship is one with the tradition of honoring mothers on Mothers’ Day, perhaps you could encourage your religious leaders to revise their message by reminding their congregations that families come in many shapes and sizes, that not all families include living mothers, and that families who have experienced the loss of a mother, the loss of a pregnancy, the death of an infant or infertility deserve to feel emotionally safe when they come to worship, including on Mothers’ Day.

So, as May 8 approaches, and as you and your family think of how, or whether, you will celebrate this day, please also take some time to be thoughtful about your interactions with others. Don’t make assumptions, offer comfort when it would be appreciated and, when in doubt, ask what you can do to make May 8 a positive experience for a friend or a loved one.

Monday, April 18, 2011

How to Adapt Stress-busting Strategies for Really Tough Problems

When life is filled with too much pressure, we either cave or we decide to deal with it. If you’re on the “deal with it” team, you may feel apprehensive about how to identify strategies that will work. In today’s blog I’ll suggest some ways you can gather strength and resources to reduce the stress that threatens to become a way of life.

In my most recent blog (Life Happens – But what about the stress it generates?), I offer some strategies for identifying and dealing with the small-time irritants in your life. These strategies are good practice for the time when you need to take on larger sources of stress, our focus for today. These larger sources of stress could have to do with health (cancer), life dreams (infertility), finances (debt), work (too much of it), or any number of other issues that have you in a stranglehold. The common thread these diverse issues share is that they have claimed more of your time and energy than you want to give – AND that they seem too tough to tackle successfully.

So here is where we need to get clear about a few things: How do we define the issue we want to change? What kind of change do we want? What do we call “success?” What resources are available to help with the issue?

Defining the issue. This is actually very important, since it’s easy when we’re overwhelmed to lump together a whole variety of issues. Sometimes defining the issue clearly places it in manageable proportions – but not always, for sure! So, using the issue of infertility, let’s define the issue as “I want to have a baby.”

What kind of change do you want? First you’ll need to consider how you have already tried to address the issue that is causing you stress. You don’t want to keep banging your head against an unyielding wall. So deciding on the kind of change you want amounts to looking for a previously invisible gate in that wall. In that effort, you’ll need to look more carefully at whether your definition of the issue could be broadened, allowing for more flexibility in the changes you are willing to consider. It also is a time when you should open your mind up to possibilities you may not have been willing to consider before. So, using the infertility example, you might re-visit your definition in #1 and reframe it as “I want to be a parent.” By doing that, you move beyond your initial issue of becoming a birth parent and broaden the kind of change you want to “parenthood,” which could come about through your willingness to consider donated eggs, donated sperm, donated embryos, surrogacy, adoption and, maybe, foster parenthood.

What do you call “success?” With a clearer and more flexible idea of changes that would be acceptable, you may want to identify more than one measure of success that would bring you relief or satisfaction. Ideally, “success” specifies something over which YOU have some control. Success can be in mini-steps, with you feeling satisfaction each time you move forward even a bit. So, let’s say that, using our infertility example, you define success as completing the paperwork for an international adoption. The mini-steps could include reading books on adoption; sharing your hopes with close family and friends; becoming acquainted with some adoptive families in your community; deciding the country from which you hope to adopt; identifying an reputable adoption agency; increasing the funds in your adoption savings account; meeting with the agency staff to learn their expectations for prospective adoptive parents and, finally, completing the necessary paperwork to move the adoption forward. Taking these small mini-steps has made it possible for you to feel small successes and increasing confidence in your decision to pursue adoption as the previously invisible gate in the wall leading toward parenthood. When setbacks occur, as they inevitably will, it is important to have a foundation of some mini-successes to bolster you as you regroup and take a new route.

The resources you identify will be very important as you encounter the inevitable setbacks that may be associated with your issue. In my earlier blog, I mention partners, loved ones, religious leaders, physicians and counselors as possible resources. Here is where you need to look at the issue as you have defined it and decide what network of helpful people you need to consult as you move forward. Ask trusted and experienced people for names of the professionals they would recommend.

And don’t try to do too much! It is better to move slowly and carefully than to get tangled up in frustrating details associated with your issue. Remember that your goal is to make progress in moving through that once-invisible gate in the wall. Take your resourceful colleagues along with you so you and they can feel like partners-in-success. There’s nothing as joyous as being able to celebrate mini-successes together! So, with infertility as our issue, possible resources could include family members, local adoptive families, a financial advisor, adoption agency professionals, travel agents, pediatricians, attorneys and language tutors.
There’s no question that feeling stressed and pressured is emotionally exhausting. And it is worse when you have been working for months or years on trying to grapple successfully with an issue that just won’t yield to your persistent efforts to bring about change. So today’s blog shifts the emphasis from “try harder” to “look for the invisible gate in the impenetrable wall.” And remember to recruit friends and experts, since their partnership in opening that gate can be invaluable!

Monday, April 11, 2011

Life Happens -- But what about the stress it generates?

Feeling overwhelmed happens to all of us. For some of us it’s occasional, for others it seems like a way of life. The causes can range from relationship problems to chronic health concerns like infertility or cancer, with hectic lifestyles usually weighing in with their share of stress. So what to do when life is filled with just too much pressure?

As I’ve counseled people over the years, the one thing I’ve learned is that troubles arise from a whole variety of complex situations. Being able to be as clear as possible about the source of stress can go a long way toward getting it under control. And, if you’re feeling overwhelmed, it’s likely that there’s more than one source of stress to contend with. Many people find it’s helpful to make a list of what is stressing them out, and then putting that list in some order, with the most stressful situations as the top, working down to the least stressful ones at the bottom. As you review your list, very likely you’re saying “No wonder I feel overwhelmed!” And just that admission can go a long way toward helping you feel less crazy and, hopefully, more ready to take the proverbial bull by the horns and work on the issues like a skillful matador.

So, once you’ve named your troubles, another step is to think through the resources you have available to grapple with them. Are loved ones available to help in any way? If they’re part of your stress, are they feeling troubled enough that they’d cooperate in seeking some relief? Could you brainstorm with a good friend who has your best interests at heart? Is your religious leader someone who might help you sort through some of the challenges you’re facing? Would it be a good idea to see your family doctor, either for relief from physical symptoms or for a referral to a specialist? Could a counselor be helpful? In my recent book When You're Not Expecting, as well as in earlier blogs, I provide information on how to find an appropriate therapist, including ways of doing this without a significant outlay of money.

So, now that you have your list of stressors, as well as a list of resources, what’s next? I’m a great believer that success breeds success, so unless you are feeling completely unglued by the issues at the top of your list, my first suggestion would be to tackle two items toward the bottom of your list. These should be items that are troublesome and irritating but, at the same time, capable of showing some improvement. Do one at a time, involve friends, loved ones, or others if they’re willing, and hopefully in a week or two you’ve been able to calm down some troubling issues and feel some mastery over them. Notice, I didn’t say you’d removed them, because some sources of stress aren’t removable so much as they are improvable. Now, keep an eye on these lesser troubles (or ask someone’s help in monitoring them so they stay stable), and go to the middle of your list. Choose one issue there, figure out what resources are available to call on for help, emotional strength, financial assistance or whatever, and make a plan to address this problem.

• What does it mean to make a plan? The most important thing will be to identify what your goal is. (What changes do you want to see? Who needs to make these changes? What changes will you need to make? When will you know you have reached your goal?) You also need to ask yourself if your goal is realistic; if it isn’t, then you’re setting yourself up for feelings of failure and frustration. A goal isn’t necessarily a full solution to the problem if that’s not realistic; it can be a change in the problem that makes it more bearable. Just remember that every change you are able to make lightens your load emotionally and gives you more energy to give to other problems on your list.

• Another important component of a plan is a timeline. Don’t ask too much of yourself or others too soon. Remember, this issue took some time to develop, and it’s going to take some time to unravel it. So try to set a realistic timeline, and be prepared to revise it to a faster or a slower pace depending on how your change efforts are working.

• Pause from time to time and pat yourself (and others) on the back for the progress being made. Even little changes deserve attention, encouragement, and ongoing support.

• It’s a good idea to revisit your goal and to reassess whether it remains as realistic as you initially hoped. By now you’ve had a chance to try out various strategies, engage the cooperation of others, and see how committed others are to change. If you decide your original goal needs to be redefined, fine. You’ll base your new goal on new information and behavior, so hopefully you’ll have a better chance of reaching that goal.

• When you believe you have moved as far as possible toward achieving your (perhaps revised) goal, it’s time to decide what needs to happen so that there’s no (or as little as possible) backsliding away from the changes that have occurred. Maintaining these changes may take some energy, but hopefully some of this energy can be supplied by others who have cooperated in making the changes.

• And now it’s time to move higher on your list…

Why didn’t we start here in the first place? For one thing, now you’ve had some practice in problem solving AND you’ve had some successes AND you have fewer problems on your list AND perhaps you already are feeling less overwhelmed. In short, you’ve reached some goals, involved some resources, begun to feel as if change is possible, and hopefully have the energy to take on a tougher problem. So what will be different as you tackle a #1 or a #2 problem on your list? Probably its difficulty.

Simply by virtue of having risen to the top of your list, this is a compelling problem. It seems to you as if it interferes with your capacity to get on with your life. It probably is something that involves other people in some way. And, very possibly, it has resisted earlier efforts to bring about change. So here is where you’ll want to give yourself some “subgoals” rather than just the one big goal of erasing the problem or reducing it considerably.

So, watch out for next week’s blog, when I’ll take on the challenge of problems at the top of your list. In the mean time, how about trying out this blog’s strategies on a stressor or two at the bottom of your list? That way, you’ll already be polishing your problem solving skills and hopefully reducing those feelings of being overwhelmed. Sure, life happens. But you can play a role in steering clear of the worst potholes by strengthening your resilience! Tune in next week….